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Organization
DIAGNOSTIC CLINIC MEDICAL GROUP INC
Active
Organization
DIAGNOSTIC CLINIC MEDICAL GROUP INC
Active
Parent organization
DIAGNOSTIC CLINIC MEDICAL GROUP INC
Other names
Diagnostic Clinic Medical Group, Inc.
Organization subpart
Yes
Provider details
NPI number
Legal business name
DIAGNOSTIC CLINIC MEDICAL GROUP INC
Authorized official
GINA MARIE PREBECK (VP OF OPERATIONS)
(727) 559-9461
Entity
Organization
Contact information
Practice address
6735 CROSSWINDS DR N, SAINT PETERSBURG, FL 33710-5471
(727) 548-8500
(727) 501-7328
Mailing address
6735 CROSSWINDS DR N, SAINT PETERSBURG, FL 33710-5471
(727) 548-8500
(727) 501-7328
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
—
NULL
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
07/15/2021
Last updated
07/15/2021
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